Dentistry and OMFS. Dalhousie Mini-Medical School 2018 Dr. Trish Brady BSc, DDS Dr. James Brady BSc, DDS, MD, MSc, FRCDC

Transcription

1 Dentistry and OMFS Dalhousie Mini-Medical School 2018 Dr. Trish Brady BSc, DDS Dr. James Brady BSc, DDS, MD, MSc, FRCDC

2 Introduction Dr. Trish Brady, BSc, DDS Grew up in Halifax Bachelor of Science degree from St.F.X.U Doctor of Dental Surgery degree from Dalhousie Owner and practicing dentist at Spring Garden Dentistry

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5 Introduction Dr. James Brady BSc, DDS, MD, MSc, FRCDC Grew up in Tyne Valley, PEI Bachelor of Science degree from Acadia Doctor of Dental Surgery from Dalhousie General Practice Residency from UWO Medical Doctor degree from Dalhousie Masters of Science in Oral and Maxillofacial Surgery from Dalhousie Fellow of the Royal College of Dentists of Canada Fellowship training Glasgow, UK

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7 What is Dentistry Dentistry is a health science consisting of the study, diagnosis, prevention and treatment of diseases, disorders and conditions of the oral cavity Including: Dentition (teeth) Gingiva (gums) and oral mucosa Bone

8 Applying to Dentistry at Dalhousie Up to 40 students accepted Academic Requirements 60 university credit hours with specific prerequisite courses (biology, chemistry, physics, microbiology, physiology, organic chemistry, writing course) Non-academic Requirements DAT (Dental Aptitude Test) Health Requirements TB testing, immunization, CPR training

9 Dalhousie Dentistry 4 year program Years 1&2 mostly didactic Years 3&4 mostly clinical Cost: $179, Range $40K-$55K per year Upon graduation Practice as a GP dentist Own and run a dental practice Practice as an associate working for an owner dentist GPR (General Practice Residency) Specialize in a particular field of dentistry

10 Specialties of Dentistry 1. Periodontics 2. Endodontics 3. Pediatric Dentistry 4. Orthodontics 5. Oral and Maxillofacial Surgery 6. Prosthodontics 7. Oral Pathology 8. Oral Radiology

11 Tooth Numbering System

12 Tooth Numbering System

13 TOOTH ANATOMY Enamel Dentin Tooth layers Pulp

14 Dental Caries Cavities or tooth decay Breakdown of tooth structure (enamel and dentin) caused by the acids produced by bacteria 2 requirements for cavity formation: 1. Bacteria 2. Plaque food source for bacteria

15 Dental Caries Abscess

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17 Enamel Tooth layers Dentin Pulp

18 Pulpal Diagnosis Alive Pulpitis Dead *No response *Face swollen *Fistula Reversible Irreversible *Spontaneous Pain *Lingering Pain (> 1hour) *Nocturnal

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20 Periodontal Disease

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23 Tooth Loss Causes Tooth decay Periodontal disease Cracked/fractured tooth Consequenses Decreased chewing function Shifting/tilting of adjacent teeth Posterior Bite Collapse Excessive or uneven wear of adjacent teeth

24 Options for tooth replacement Dental Implant Bridge Removable Partial Denture

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26 Bridge

27 Removable Partial Denture

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29 Mini Med School OMFS Facial Trauma Dr. James Brady

30 ATLS PRIMARY SURVEY Airway and C-spine control Breathing and adequate ventilation Circulation Degree of consciousness Exposure

31 SECONDARY ASSESSMENT Need to reeval vital signs throughout. If at any time there is a significant change in status go back to primary survey. Head to toe IPPA (inpection, palpation, percussion, auscultation)

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35 Mandible fractures

36 Etiology of Mandibular Fractures 43% due to MVC 34% due to assaults 7% are work related 7% due to fall 4% due to sporting accidents.

37 Coronoid process Condylar process Angle Ramus Body Parasymphyseal

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39 Location of Mandibular Fractures

40 Facial fractures associated with mandibular fractures Mandible is the only bone fractured in 70% of patients. Number of fractures per mandible: approximately 50% have more then one fracture. 53% one 37% two 9% three.

41 Pattern of fracture 1. Simple or Closed: no wound open to external environment. 2. Compound or Open: open to external environment. 3. Comminuted: bone splintered or crushed. 4. Greenstick: one cortex of the bone is broken, the other bent. 5. Pathologic: from mild injury because of preexisting bone disease.

42 Indications for Closed Reduction NOT ALL THAT COMMON 1. Nondisplaced favorable fractures 2. Grossly Comminuted Fractures 3. Coronoid process fractures

43 Length of Fixation In general for uncomplicated fractures: Children: IMF 2 to 3 weeks Adults: IMF 3 to 4 weeks Older patients: IMF 6 to 8 weeks.

44 Indications for Open Reduction MOST COMMON 1. Displaced unfavorable angle fractures 2. Displaced unfavorable body or parasymphyseal fractures 3. Multiple fractures of the facial bones 4. Midface fractures and displaced bilateral condylar fractures 5. Fractures of an edentulous mandible with severe displacement of the fractured fragments 6. Edentulous maxilla opposing a mandibular fracture 7. Delay of treatment and interposition of noncontacting displaced fracture fragments soft tissue between 8. Malunion 9. Special systemic conditions contraindicating IMF Seizure psychiatric or neurologic disorder Compromised pulmonary functions Gastrointestinal disorder

45 Fixation Rigid Non Rigid Load Bearing Load Sharing

46 Fixation Rigid Non Rigid Load Bearing Load Sharing

47 NonRigid Internal Fixation Examples Functionally stable fixation Single miniplate technique of treating mandibular angle or body fractures = The Champy Method

48 The Champy Method: Single, noncompression miniplate attached with 2.0 mm monocortical screws. Because this plate is placed in the most biomechanically advantageous area for this region (superior border), a small plate can neutralize the functional forces and permit active use of the mandible during the healing.

49 Fixation Rigid Non Rigid Load Bearing Load Sharing

50 Load-Bearing Fixation RIGID FIXATION Load-Bearing Sufficient strength and rigidity that it can bear the entire load applied to the mandible during functional activities.

51 RIGID Load-Bearing Fixation Mandibular reconstruction bone plate Required in: Comminuted fractures of the mandible Fractures where there is very little bony interface because of atrophy Injuries that have resulted in a loss of a portion of the mandible (defect fractures)

52 Atrophic mandibular fracture In the atrophic mandible a stronger bone plate should be applied below the inferior alveolar canal.

53 Fixation Rigid Non Rigid Load Bearing Load Sharing

54 RIGID Fixation Load-Sharing Fixation Internal fixation that is of insufficient stability to bear all of the functional loads applied across the fracture by the masticatory system.

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57 Case #1

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61 Left Subcondylar

62 Case #2

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66 Right angle

67 Case #3

68 Trans buccal approach to angle

69 Left angle # Right Body #

70 Case #4

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74 Right Subcondylar

75 Case #5 (Review of Surgical Approach) Fell off the back of a truck while car surfing the night before

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77 CT Nov 14,2015

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87 Procedures: ORIF Left parasymphyseal # (intraoral) Right Subcondylar # (transparotid) Left Subcondylar # (transparotid) Chin laceration repair

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91 Down to Masseter (Different Case)

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95 Case #6

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97 Left body # Right Scubcondylar # Right Ramus #

98 Study Design A retrospective study was carried out on all patients who underwent open treatment (ORIF) of their condylar fractures at our center Atlantic Centre for Oral and Maxillofacial Surgery in Halifax, Nova Scotia Study Period: September 2015 and February 2018 Type of fracture, surgical approach used, facial nerve weakness and the number of plates used for fixation were all recorded. All fractures were grouped based on the AO classification of condylar fractures.

99 Results TPA SMA Fractures (patients) 18 (14) 27 (24) Type 11 Subcondylar 7 Neck 25 Subcondylar 2 Neck Facial Nerve Injury 0/18 (0%) 6/27 (22%) 2-Plate Fixation 18/18 (100%) 25/27* (93%) *= 2 Neck Fractures

100 Case #7 8 yo girl Running outside at school and ran into another boy s shoulder.

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104 Left Body # Right Parasymphysis #

105 Case #8 8 yo boy Was lying on ground during recess when he was clobbered by a girls foot as she was completing a cartwheel!

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109 Post Op

110 Left Parasymphysis Right Body

111 THE END Questions???